Outcome of Revision Surgery for Infection After Total Knee Arthroplasty

Abstract

Background: Periprosthetic joint infection (PJI) after knee arthroplasty surgery remains a serious complication, yet there is no international consensus regarding the surgical treatment of PJI. This study aimed to assess prosthesis survival rates, risk of revision, and mortality rate following different surgical strategies (1-stage versus 2-stage implant revision and irrigation and debridement with implant retention) that are used to treat PJI. Methods:The study was based on 644 total knee arthroplasties (TKAs) that were revised because of a deep infection (i.e., surgically treated PJI) and reported to the Norwegian Arthroplasty Register (NAR) from 1994 to 2016.Kaplan-Meier and multiple Cox regression analyses were performed to assess implant survival rate and risk of revision. We also studied mortality rates at 90 days and 1 year after revision for PJI.Results: During the follow-up period, 19% of the irrigation and debridement cases, 14% of the 1-stage revision cases, and 12% of the 2stage revision cases underwent a subsequent revision because of a PJI. The 5-year Kaplan-Meier survival rate with revision for infection as the end point was 79% after irrigation and debridement, 87% after 1-stage revision, and 87% after 2-stage revision. There were no significant differences between 1-stage and 2-stage revisions with subsequent revision for any reason as the end point (relative risk [RR], 1.7; 95% confidence interval [CI], 0.9 to 3.5) and no difference with revision because of infection as the end point (RR, 1.6; 95% CI, 0.7 to 3.7). In an age-stratified analysis, however, the risk of revision for any reason was 4 times greater after 1-stage revision than after 2-stage revision in patients over the age of 70 years (RR, 4.3; 95% CI, 1.3 to 14.8). Age had no significant effect on the risk of subsequent revision for knees that had been revised with the irrigation and debridement procedure. The 90-day and 1-year mortality rates after revision for PJI were 1.2% and 2.5%, respectively.Conclusions: Irrigation and debridement yielded good results compared with previous published studies. Although the 1-stage revisions resulted in a fourfold increase in risk of subsequent revision compared with the 2stage revisions in older patients, the overall outcomes after 1-stage and 2stage revisions were similar.

Effect of a multidisciplinary team on the treatment of hip and knee prosthetic joint infections: a single-centre study of 154 infections

“…Two-stage exchange was the standard surgical method for treating a PJI earlier [1,2,13,14]. It is expensive, requires 2 operations, leads to an increased LOS [6], causes morbidity and mortality [3], and may lead to impaired and painful joint function [14][15][16][17].…”

“…Two-stage exchange was the standard surgical method for treating a PJI earlier [1,2,13,14]. It is expensive, requires 2 operations, leads to an increased LOS [6], causes morbidity and mortality [3], and may lead to impaired and painful joint function [14][15][16][17]. More tolerable options are available for selected cases, including one-stage exchange [1,2,14,18] and debridement, antibiotics, and implant retention (DAIR) [1,2,14,16,17,19,20].…”

“…It is expensive, requires 2 operations, leads to an increased LOS [6], causes morbidity and mortality [3], and may lead to impaired and painful joint function [14][15][16][17]. More tolerable options are available for selected cases, including one-stage exchange [1,2,14,18] and debridement, antibiotics, and implant retention (DAIR) [1,2,14,16,17,19,20]. DAIR, when successful, demonstrates better functional outcomes compared to two-stage exchange-even similar function to that of non-infected joints [16,17,20].…”

Comparison of the success rate after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection among patients with or without a sinus tract

“…Treatment of PJI brings great suffering to patients, poses difficult challenges to surgeons and causes huge financial burdens [ 4 , 5 ]. The main treatment options involve debridement, antibiotics and implant retention (DAIR), one-stage and two-stage revision [ 6 ].…”

“…Compared with one-stage or two-stage revision, DAIR has the advantages of lower cost, lower skill requirement and better postoperative joint functions [ 7 – 9 ]. Numbers of cases treated with DAIR have increased rapidly in recent years [ 6 , 10 , 11 ]. However, the infection control rate after DAIR ranges from 10 to 100% in different studies, and the overall infection control rate in a recent meta-analysis is approximately 60% [ 12 ].…”